Understanding my Deductible/co Insurance/out of Pocket Max.

[Mapper]

Unfortunately the airlift bill will be an out of network expense. Yet some of it should be discounted as an out of network deductible (which is 2X Reg deductible).

They don't discount in WA since they know they have you stuck in a life or death situation.

There are some exceptions. Definitely need to look at the fine print.

However, he paid for airlift insurance from Airlift NW this year for $79 for the year. They are supposed to cover everything that the health insurance doesn't cover. Airlift NW has a reciprocal program with the company that airlifted him.

We also keep getting asked about our auto insurance and they need to know about any claims they have before the health insurance processes it. We keep telling them that his motorcycle has very minimal insurance since it is only used on a racetrack and does not cover injuries. They won't deny any claims because they think the auto insurance should cover it, will they? The thing is, he had another bad accident on the track back in May and was hospitalized and not once were we asked about our auto insurance. This time we've been asked about it as least half a dozen times.

 

[Yagents]

Insurers Find Out-Of-Network Bills As Much As 1,400 Percent Higher | Kaiser Health News

1400% for OON charges ? Is that all?

 

[Mapper]

It's been about a month since we've had any kind of mail about H's hospital bill. Yesterday we got a letter from the hospital saying that "insurance is denying your claim because they have yet to receive back from you the auto insurance questionnaire that was sent to you. Please contact your insurance to resolve this so that they can process it." Okay 1) H got two of those in the mail and sent them back both times saying that our auto insurance will not cover any injuries regarding the motorcycle and 2) Why, when he had the same kind of accident on a racetrack 4 months prior and had to be in the hospital, were we never once asked about our auto insurance? This time we've been queried on it at least a half a dozen times.

Are they just trying to exhaust every avenue before the health insurance pays out? I mean the health insurance won't NOT pay out will they because there's no auto to cover the motorcycle? It's a $54,000 bill so they had better cover a majority of it!

 

[junkman]

All carriers that provide health or accident coverage of any type will be involved. They all have to pay subject to the contract specs but they don't pay in total any more than the claim. This is to stop people from "profiting" from insurance.

Suppose you had a claim for $500,000 and 2 carriers. If they both paid equally, you could essentially pocket $500,000 less the out-of-pocket.

Give the medical carrier the information about the motorcycle insurance. If you sent it, call and get a real person and email it to them so you have a record. Let the carriers fight it out. Find out who the agent is. If this is a large case, they will know or can find out who can help.

Keep in touch with the medical providers that you owe money to. You want to keep them from sending your bill collections and screwing up your credit. Don't pay anyone until you're satisfied that claims are filed and paid correctly.

You can negotiate your final bill down. Just ask for a "prompt payment discount". Say something like "I have $xxxx in outstanding medical bills and am going down the list and paying those that give me a discount first. Can I have 20% off your bill?" Then be quiet until they answer. If the person doesn't have the authority, find out who does. Expect 10%. It doesn't matter how long the bill has been outstanding. Ask for the discount. Don't pay until the claim settles completely. (You could pay any individual doctor that you have an ongoing relationship with but don't over pay.)

Charges are applied to the deductible and OOP in the order that the carrier receives them. I've asked my doctor to hold their claim until the hospital files. That way I owed the hospital the entire OOP. They worry more about getting paid when the insured owes several thousand dollars.

Keep records and document everything. You should have a separate file for this with dated notes. (They keep records of what they think you said. Ask them if they are documenting and have them read their netes back to you so you have a change of getting the correct details into their record.)

Don't pay the agreed amount until you have the agreement in writing. You want verbiage similar to they are willing to take $xxxx as settlement in full. Otherwise, they could claim that they "wrote off" the discount as a bad debt which could damage your credit.